Did you know that South Asians (Indian, Pakistani, Bangladeshi, Nepali and Sri Lankan) have high rates of heart attack and stroke?

60% of the world’s heart disease patients are South Asian and we have the highest death rate from heart disease in the US compared to other ethnic groups. Sadly, risk factors also seem to occur at a younger age in South Asians.

Until recently, there has not been much data available for the risk factors associated with this demographic. In the US, risk stratification and management has been based on studies in which the population was mostly not Asian.

A collaboration of scientists from India and the US (UCSF and Northwestern University) is performing studies to better understand the risk factors for cardiovascular disease- it is called MASALA (Mediators of Atherosclerosis in South Asians Living in America). It was the first and only study of its kind when started in 2010.

An example of an important finding by the group has been that risk of diabetes in South Asians sharply goes up at a lower BMI than for other populations- at a BMI of 23 (which is a “normal” BMI). This led the American Diabetes Association to change recommendations for this population.

Risk calculators used to predict cardiovascular risk for the general population may underestimate the risk in South Asians. We may be able to better define an individual’s risk by looking beyond the traditional risk factors like high blood pressure, high cholesterol, low HDL cholesterol, diabetes and smoking.

I would venture to say that we should also be looking at these factors earlier in this population.

A common thread amongst all risk factors for heart disease is INSULIN RESISTANCE. See my prior blog posts that describe this syndrome further. It is a process that eventually leads to diabetes, inflammation, fatty liver, increased risk for stroke, heart attack and cancer!

It does not happen overnight, so we should be able to detect this process earlier so we can apply changes to our diet, lifestyle, intervene earlier with appropriate medications and work to optimize weight and abdominal fat BEFORE we end up with disease.

What are some of these measurements and tests that could allow us to detect these risk factors earlier? How can we know if we may be at risk? What things can we monitor?

Waist size: For South Asian men, waist size above 90 cm or 35 inches and for women, over 80 cm or 31 inches

Lipoprotein Analysis: Studies indicate that insulin resistance causes our lipids sizes and types to change. These changes are not evident on your routine blood work. When lipoprotein analysis is performed, often times, abnormalities like increased LDL particle number and small dense LDL (that may cause more cholesterol plaques) become evident while other traditional measurements appear “normal”.

Insulin levels: When insulin resistance is present, our body is not responding to insulin, which makes our pancreas have to “turn up the volume” to be heard- we can detect abnormally increased insulin levels by checking this in a fasting blood sample. Again, this is not a test that is done in the traditional annual lab testing.

Highly sensitive C reactive protein: Insulin resistance leads to a state of inflammation, that can be detected with this type of blood test (hsCRP).

Coronary Calcium Score by CT

Carotid Artery Intima Media Thickness

What else can we do?

Knowing that as South Asians, we are more susceptible to insulin resistance & consequently heart disease, likely as a result of the interplay between our genetics and environment (lifestyle, food, stress to name a few), we need to shift our mentality to one that is preventive.

Do not take comfort in “normal” lab tests that may not be abnormal yet, based on where you are on the spectrum of disease risk factors.

We have to focus on proper nutrition, reducing processed carbohydrates (break the sugar/carb addiction), managing stress and by increasing physical activity.

We can eat a diet that is heavy on plant-based foods that allow us to get lots of fiber, vitamins, monounsaturated fats and proteins. Meat, dairy and fish can definitely be a part of this kind of lifestyle if also watching portion sizes and not eating in excess at all times of the day.

Perhaps a simple way to phrase this idea: Eat to live, not live to eat.